Transcript ชมรมโรคระบบหายใจและเวชบาบัดวิกฤตในเด็กแห่งประเทศไทย ร่วมกับ ยูโรดรัก ลาบอราทอรีส์ พญ.มุกดา หวังวีรวงศ์ หัวหน้ าหน่ วยโรคภูมิแพ้ สถาบันสุขภาพเด็กแห่งชาติมหาราชินี Role of Theophylline • The role of theophylline in the long term treatment of childhood asthma.

ชมรมโรคระบบหายใจและเวชบาบัดวิกฤตในเด็กแห่งประเทศไทย
ร่วมกับ ยูโรดรัก ลาบอราทอรีส์
พญ.มุกดา หวังวีรวงศ์
หัวหน้ าหน่ วยโรคภูมิแพ้
สถาบันสุขภาพเด็กแห่งชาติมหาราชินี
Role of Theophylline
• The role of theophylline in the long term
treatment of childhood asthma is limited,
but its low cost may justify more frequent
use in some countries
• Concomitant intake of food may change
the absorption
Role of Theophylline
• Sustained-release theophylline
may be used as an alternative to
inhaled steroids for maintenance
therapy in mild persistent asthma
• Add on therapy with a low dose
inhaled steroids
School children
• Theophylline is significantly more effective
than placebo at controlling symptoms and
improving lung function, even at doses
below the normally recommended
therapeutic range (Evidence A)
• Single-dose 15 mg/kg of sustained-release
theophylline taken before bedtime is
effective at preventing nocturnal symptoms
School children
• Prevent exercise-induced asthma
in long-term maintenance
treatment
• Theophylline + oral beta 2agonists seem to have an additive
effect on control of asthma
Preschool children
• Some beneficial clinical effects,
such as bronchodilation in this
age group (Evidence C)
Infants
• Has not been assessed
Goal of therapy
Theophylline for chronic asthma
Obtain maximum potential
benefit with minimum risk of
adverse effects
Clinician’s concern
• Monitoring of plasma levels : a must???
• Drug dose cannot be universally corelated with plasma levels
• Erratic pharmacokinetics of
theophylline
• Inter-patient variability due to individual
metabolic peculiarity
Clinician’s concern
• Clinically dangerous & doserelated drug interactions with
quinolones, macrolides
• Consequent poor patient
compliance and high dropouts
• Major inter-formulation variations
in drug release patterns
Ideal Methylxanthine
• Provide effective bronchodilating properties
in obstructive diseases such as asthma and
COPD
• Free from dose-related acute toxicity
• Unlikely to exhibit adverse effects at usual
therapeutic doses
• Free from need for repeated serum level
measures
• Suitable for most patients requiring
treatment e.g. elderly, children and high risk
groups (cardiac, GI ulcers patients,etc)
O
H
H
N
N
O
O
XANTHINE
O
N
O
CH2
H3C
N
N
N
DOXOPHYLLINE
H
O
H3C
H
O
N
N
N
N
CH3
N
CH3
THEOPHYLLINE
O
N